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[Dana]

Just wondering if anyone has had any experiences with the alternate day dosing method of 100mg Utro. How effective/safe do you think it is as a conti method?

I did try it a couple of years ago, for a few months, but I kept getting break through bleeds, but maybe I didn't give it enough time to settle in.

[Cassie]

I am not entirely sure that its a good idea, I think everyone is different, what is your reason for wanting to use the Utro this way? If it is to cut back, then I would rather use it 15 days in a row, else you are likely to get breakthrough bleeding as your levels dip and rise again. I am sure that someone else will be along shortly who can advise... I take Utro 100mg for 12 days in a row and that seems to be working well, so far so good, touch wood Of course used that way, it will not be conti and you will get a bleed, but I would imagine you will get bleeds or at least breakthrough bleeds, used the other way as well...

[Sarah2]

Dana- conti means 'continuous'!
It's not meant to be alternate days for the reasons Cassie has said.
The levels particularly of Utrogestan will rise and fall too much and are likely to give you bleeding.

If you want to reduce the amount you take then it would be better to take less but over 15 days, or 21 days.

[Hurdity]

Sarah2 - for the purposes of HRT every alternate day is also conti. Conti means the same dose is taken continuously without a break for a withdrawal bleed. It doesn't have to be every day.

The alternate day regime though is only suited to vaginal or rectal methods of getting progesterone though - because of the lower availability of progesterone taken orally, as you say.

Dana - I briefly reduced to 25 mcg oestrogen patch a few years ago and took Cyclogest 200 mg every other day (normal dose for cyclical HRT was 400 mg ie twice as much as Utrogestan) - this was a conti regime, but an unofficial one. I worked out the dose along with another member on here and we agreed it together! It did seem to work but my oestrogen dose was low

There was a prospective study done which was published in Climacteric in 2010. I have a copy of the paper but not the ref and as it's pdf can't quote easily from it  - but could send you a copy by e-mail if you pm me your e-mail address Dana. It was a trial on 30 post-meno women given vaginal P along with oestrogen gel. The outcome was favourable re reducing oestrogen stimulation of the endometrium - but it was only a small study, and would be important to do this under medical supervision only, and only for vaginal use of progesterone.

Hope this helps.

Hurdity x

[Dana]

I am not entirely sure that its a good idea, I think everyone is different, what is your reason for wanting to use the Utro this way? If it is to cut back, then I would rather use it 15 days in a row, else you are likely to get breakthrough bleeding as your levels dip and rise again. I am sure that someone else will be along shortly who can advise... I take Utro 100mg for 12 days in a row and that seems to be working well, so far so good, touch wood Of course used that way, it will not be conti and you will get a bleed, but I would imagine you will get bleeds or at least breakthrough bleeds, used the other way as well...

No particular reason. I'm just curious about other people's experiences, and if they are willing to share. It's just all about being informed of all our options.

[Dana]

Dana- conti means 'continuous'!
It's not meant to be alternate days for the reasons Cassie has said.
The levels particularly of Utrogestan will rise and fall too much and are likely to give you bleeding.

If you want to reduce the amount you take then it would be better to take less but over 15 days, or 21 days.

I do know what "conti" means, and as Hurdity has noted this is considered a "conti" method. Maybe because you haven't been a member of MM for that long, you aren't aware of the fact that there have been women on MM and other meno forums who have used this method in the past. I was just interested in their experiences. It may or may not work for some women. That's why we ask these questions.......

[Sarah2]

http://www.nhs.uk/Conditions/Hormone-replacement-therapy/Pages/How-it-works.aspx


Continuous combined HRT

Continuous combined HRT is usually recommended for women who are post-menopausal. A woman is usually said to be post-menopausal if she has not had a period for a year.
As the name suggests, continuous HRT involves taking oestrogen and progestogen every day without a break.



Isn't the reason for continuous so that levels in the blood stream remain constant?

[Hurdity]

Sarah - the important point about what we are discussing, is not the definition, but what is meant by a continuous combined method as I said below ie one without a withdrawal bleed. As I mentioned what we are talking about (alt day vag use of utrogestan) is one that is not licensed or generally used (which is why the definition is as you correctly reported below) but as you know there are all sorts of variations to the regimes mmainly tried by specialist gynaes or private consultants.

This particular one as I pointed out was the subject of a trial and as such is of interest to those who do not wish to take progesterone every day.

Although the study does not mention serum levels of progesterone, the point about these is that vaginal application delivers progesterone directly to the uterus and serum levels will be more stable than with oral use - ie not subject to the vagaries of the digestive system and liver. The result from this limited trial showed the majority of women had no bleeding after an initial settling in period of a few months.

Some women withdrew from the study because of bleeding - and as expected this would not suit every individual just as with HRT preparations now - but it sounds like a promising possibility that could suit women who don't want high doses of progesterone.

The main problem would be re sexual intercourse as I am sure this would upset the progesterone levels so many women would not want to take this on an alternate day basis - but it depends on your circumstances!

Also personally it definitely affects my bladder - but only once or at the most twice in the night - and I can live with that 12 days every 8 weeks, but wouldn't want to do this every other day.

You're right Stellajane, there was someone who did this.

Also Sarah - you're right re blood levels - I doubt whether 100 mg oral Utrogestan on alternate days would achieve this - and I imagine there would be more spotting, and perhaps greater incidence of endometrial hyperplasia.

Hurdity x

[Sarah2]

I think it's only something someone should try if they were having regular-ish scans.

Although it's fine to take lower amounts of Utrogestan- Studd for example suggests 7 x 100mg per 4 week cycle which is pretty low- that dose will still bring on a withdrawal bleed.

The potential issue with alternate-day doses of 100mgs is perhaps it won't necessarily promote a bleed as there is no withdrawal,( but there may be spotting) but on the other hand it may not be enough to prevent endometrial thickening, especially if it's taken orally.

How would anyone know without a scan?


Is there any research on this?

[Cassie]

I was on 7 days of 100mg was getting a monthly bleed so thought I was ok, until I started getting breakthrough bleeds and discovered on scan that my lining was rather thick! I personally couldn't do the 7 had to go up to 12 and will see later this year how the lining is looking on that. So perhaps a bleed does not necessarily mean that the whole lining is shed simultaneously, think this was discussed on another thread?

Hurdity was that study you mentioned on using the Utro on alternate days vaginally?

[Hurdity]

As I've said before - John Studd can recommend regimes to women who are paying because they will pay for the necessary scans. He knows from his own research and trials that the incidence of endometrial hyperplasia rises with lower monthly doses of progestogen and the dosages we now have recommended in the HRT available I think are due to his pioneering work.

Re research on endometrial thickness - that was the main point of the research! ie could this dose prevent thickening, as this is the main function of progesterone in HRT, which it did. I did mention this in my first post about this research below.  Because it was such a small study, it is not sufficient for this regime to be approved and licensed but it was a promising start, and of course scans would be recommended if anyone decided to decide to do this.

Again for anyone reading this, it would be important only to do this under medical supervision and if you can afford regular private scans.

Hurdity x

[Dana]

Thanks for all your very good information Hurdity   The study is promising, but I suppose more work needs to be done, as with most things relating to HRT.

I was lurking around MM up to 2 years ago and I was aware of discussions about this method, and that there were a couple of people testing it out. So I was just trying to get an update on that information, if those people are still here posting.

I think it's good to have this kind of discussion because, as I said above, it's all about being aware of all the options available. For those who are newer to MM, it will be interesting information for them.

Of course everyone should only make changes to their HRT routines in conjuction with medical supervision.

[SusieJ]

Hello All

I've found this thread by chance  - and it's exactly what I was going to post about. I have tried endless variations of utrogestan dosage and have really struggled with sedation effects - overwhelming tiredness, detachment, inertia, fogginess. I then started to get blinding headaches. I tried all kinds of doses and routes: but struggled with all of them. Then I suddenly had the idea that the problem was taking it two days in a row as for some reason I seemed to be taking much longer to metabolise the drug than research suggests I should. So, as a final ditch attempt I agreed with my gynae that I would try taking it orally every other day. I've been doing this for three months now -  and it has been fantastic. I feel absolutely amazing: calm, brilliant skin - all the good things progesterone can give you - and none of the bad stuff. And I've not had a bleed or any spotting at all, which suggests that the dose is doing its job. i'm slowly trying to raise the number of days I take it as my body gets used to it. I'm now able to take it for four days every week, which means I'm on 2/3 of the recommended dose (16 days rather than 25) and my aim is to try to get my dose up to 20 days in a month.

This really has been a godsend for me - I was about to come off HRT as I couldn't cope with any of the progestins. However, it's obviously risky taking less than the recommended dose and I wouldn't do it without medical supervision. I'm going back to the gynae in a couple of months for a review, and suspect she'll ask me to come back for a scan in a year. Spreading the dose like this however does mean that I'm now able to take much more each month than I could when I took it every day - the most I lasted was 12 days on 100mg per day - I was then so ill I had to take time off work. So this is much, much better!

I feel really positive now: this has transformed my life. Here's hoping it stays this good...

Good luck everyone!

Susie

[Cassie]

Thankyou pls let us know how your scan looks and whether the lining shows any thickening taking it in this manner.

[Meeka]

Thanks for letting us know.  Do you mind me asking who your Gynea is?